Original articlePatient-reported reasons for the discontinuation of commonly used treatments for moderate to severe psoriasis
Section snippets
Study design
As part of a multicenter comparative effectiveness study,26 we conducted a cross-sectional study to determine the reasons for the discontinuation of systemic treatments, biologics, and phototherapy for moderate to severe psoriasis. The study was approved by the University of Pennsylvania and University of Utah Institutional Review Boards and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients.
Setting
Data were collected by 10 dermatologists and 2
Sample characteristics
Data were collected on 1755 eligible patients (5% of patients declined to participate). Among the 1158 patients who reported any previous treatment for chronic plaque psoriasis, 1095 patients reporting at least 1 previous biologic, systemic, or phototherapy were included in the analysis. Patient demographics and clinical characteristics are shown in Table I. Based on self-reported categories on the extent of psoriasis involvement at its worst, 29.5% of patients reported 3% to 10% body surface
Discussion
This study comprehensively characterized patient-reported reasons for discontinuing commonly used treatments for moderate to severe psoriasis in clinical practice. We demonstrated different patterns of reasons among systemic, biologic, and phototherapy treatments. Perceived treatment inefficacy and side effects were the predominant issues leading to treatment withdrawal; however, treatment inconvenience and economic barriers were also commonly cited, emphasizing the value of patient-oriented
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Supported by the T32-AR07465 (Mr Yeung, Ms Wan, Mr Shin) and 1KM1CA156723 (Dr Callis Duffin) training grants from the National Institutes of Health, and the RC1-AR058204 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Dr Gelfand). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.
Disclosure: Dr Van Voorhees has served on advisory boards for Amgen, Abbott, Genentech, Warner Chilcott, and Centocor; as an investigator for Amgen and Genentech; as a consultant for Amgen and Leo Pharma; as a speaker for Amgen, Abbott, and Centocor; and received honoraria from Synta. Dr Callis Duffin has served on advisory boards for Amgen; as a consultant for Amgen and Centocor; as an investigator for Abbott, Amgen, Centocor, and Pfizer; and received payments for lectures from Abbott, Amgen, and Centocor. Dr Krueger has served as a consultant for Abbott, Amgen, and Centocor; had grants from Abbott and Amgen; and received payment for lectures and travel-related expenses from Abbott, Amgen, and Centocor. Dr Kalb has served as a consultant for Abbott, Amgen, Centocor, LEO Pharma, and Stiefel; an investigator for Abbott, Amgen, Astellas, and Centocor; and a speaker for Abbott, Amgen, Centocor, Galderma, LEO Pharma, and Stiefel. Dr Weisman has served as an investigator for Abbott, Braintree Laboratories, Celgene, Cipher Pharmaceuticals, LEO Pharma, Pfizer, Norvartis, and Eli Lily; and received payments for lectures from Abbott and Amgen. Dr Sperber is the medical director of Stephens & Associates, has served as a consultant for Amgen, and had grants or has pending grants from Abbott and Centocor. Dr Bebo is employed by the National Psoriasis Foundation, which receives unrestricted financial support from Amgen, Abbott, Janssen, Stiefel Laboratories, Wyeth, Pfizer, Eli Lilly, Galderma, and PhotoMedex. Dr Gelfand has served as a consultant for Abbott, Amgen, Celgene, Centocor, Novartis, and Pfizer; had grants from Abbott, Amgen, Genentech, Novartis, and Pfizer; and received payment for continuing medical education work related to psoriasis. He received a donation from Amgen to the University of Pennsylvania to further develop Dermatology Clinical Effectiveness Research Network, which was not used for the current study. Mr Yeung, Ms Wan, Dr Brod, Dr Schleicher, Mr Shin, and Dr Troxel have no conflicts of interest to declare.
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